Shortly after publishing Patient Compliance And The F Word, my post about Jonathan Richman’s essay, The Only Way Pharma Can Improve Compliance: Fun, I serendipitously heard from Katrina Firlik, MD, who introduces herself as a neurosurgeon-turned-entrepreneur, now founder and chief medical officer of a new start-up in the medication adherence space: www.healthprize.net.
On checking that site, I found the above graphic (click on image to enlarge) which held out the promise of, as the title of this entry notes, “more adherence fun.”
Once is happenstance, twice is a trend, … one more linkage between compliance and fun and we’ll have ourselves a movement.1
HealthPrize Technologies – Motivating Treatment Adherence With Incentives
I must admit that my immediate, automatic reaction to the HealthPrize Technologies site was a flinch. Like most healthcare professionals, I am unaccustomed to seeing treatment adherence linked to winning prizes.
From the HealthPrize Technologies site:
It’s all based on the simple idea that people respond to two things: money and fun. So we’ve developed a system that links adherence-tracking technologies to a series of financial incentives, like points, prizes, and cash. And the better consumers are about taking their medication, the more chances they have to win and the more fun they’ll have.
Differing opinions about the appropriateness of offering incentives for compliance with healthcare regimens is hardly a new topic. A partial list of AlignMap posts on this issue includes
- Cash For Compliance & Other Ethical Dilemmas
- Cash For Compliance – Benefit or Bribe?
- Shopping Discounts As Incentives For HIV Screening Compliance
- Incentives To Enhance Compliance With Addiction Treatment
- Automated Incentives For Medication Adherence
- Monetary Incentives To Decrease Obesity
- Another Case Of Cash For Compliance
- Recurrent Themes: Health Literacy & Incentives
The contentiousness triggered by this methodology has more to do with cultural, philosophical, and ethical concerns than pragmatic results. There is an impressive amount of evidence that supports the notion that fiscally based incentives (e.g., cash, coupons, and merchandise) can increase rates of treatment adherence.
Currently, an odd dichotomy of opinions on the matter exists. There is relatively little criticism heard, for example, about corporate wellness programs offering prizes and other incentives to obese participants who lose weight or to tobacco-using participants who are able to stop smoking. Offering those same prizes or similar incentives, however, to participants for following a prescribed medication regimen or undergoing indicated medical screenings is likely to result in charges of unethical behavior, mind control, and disreputable motives.
Given that some bioethicists insist that only an absolutely neutral presentation of treatment options to patients is acceptable, the idea of offering prizes for executing a course of treatment is sure to result in controversy.
For my part, incentives seem one more tactic that has been shown to enhance treatment adherence in some patients. In that sense, it falls in the same category as reminders, the use of pill boxes or automated medication dispensers, regimen simplification, adding a second medication to ameliorate the primary drug’s side, educating the patient about the workings of the medication, …
The key ethical issue would seem to be distinguishing the use of incentives to drive the behaviors necessary to execute a prescribed treatment from the use of incentives to drive the mindless ingestion of one pill or another.
My (slightly paraphrased) summary from Patient Compliance And The F Word about the importance of fun as a motivator fits the aggressive incentivisation practiced by HealthPrize Technologies as well:
- It’s important because incentives have been shown to be effective for a significant number of patients (albeit not all)
- It’s important because, as I have pointed out on occasion, 2 repeating the same processes tends to produce the same results. In the case of patient compliance, that means trying the same adherence enhancement that didn’t work the first 821 times probably won’t work the 822nd time. Trying something new (not just another version of the same tired idea), is essential; trying something that has only been used on a limited scale, such as incentives, is astutely logical.
- Finally, it’s important because we need to be looking for methodologies that enhance compliance by enhancing the alliance of the patient with those involved in his or her healthcare, including clinicians, Pharma, third party payers, and other stakeholders. Fun would be a potent force to effect that alignment.
I cannot predict how effective this particular take on using incentives to improve treatment adherence will be clinically, and I certainly have no idea if HealthPrize Technologies will prove a commercial success. It does seem, however, that adding a potentially useful, currently unavailable weapon to combat certain kinds of unintentional noncompliance to our clinical armamentarium could be – well, fun.
__________- Actually, we may already have more than three such instances linking compliance to fun. See Celebrating Compliance and Compliance Enhancement: Party, Pedicure, and Potables↩
